DK177809B1

DK177809B1 - Incremental adjustable mandibular advancement device for

Info

Publication number: DK177809B1
Application number: DK201300338A
Authority: DK
Inventors: Natashia Ingemarsson-Matzen
Original assignee: Natashia Ingemarsson-Matzen
Priority date: 2013-06-02
Filing date: 2013-06-02
Publication date: 2014-07-21
Also published as: CN105246437A; JP6387087B2; JP2016519975A; EP3003234A1; AU2014277344A1; BR112015029484B1; SG11201509395WA; DK177992B1; WO2014194910A9; RU2015148422A; AU2014277344B2; WO2014194910A1; CA2912311A1; BR112015029484A2; RU2657847C2; US20140352700A1; DK201400149A1; US9545331B2; EP3003234B1; CA2912311C

Abstract

The current invention relates to an adjustable mandibular advancement device with a unique combination of resilient hinging, dentition engagement and adjustability, to prevent or reduce Snoring and/or Obstructive Sleep Apnea Syndrome. The device is made of an upper member to engage the maxillary dentition and a lower member to engage with the mandibular dentition, the members connected by a resilient hinge with embedded adjustability. The adjustability is described by means of a concept of an incrementally adjustability for the relative enlargement or diminution of the members of the device. By use of thermoplastic materials the device can be used in the outmost variability of the human dentition

Description

DK 177809 B1 INCREMENTAL ADJUSTABLE MANDIBULAR ADVANCEMENT DEVICE FOR PREVENTING AND TREATMENT OF SNORING AND OBSTRUCTIVE SLEEP APNEA.

Field of invention

The current invention relates to an adjustable mandibular advancement device which by virtue of an incremental (stepwise) mechanism, advances or withdraws 20 the mandibuiar relative to the maxilla in order to prevent or reduce Snoring and/or Obstructive Seep Apnea Syndrome (OSAS) during deep. The adjustability is accomplished by the intrinsic embedded mechanism in the two members in conjunction or separately in either of the members relative to the other.

25 Background of the invention

Snoring and Obstructive Seep Apnea are generally known today as the same disease on a continuum of the sleep disorder severity scale. Starting at the modest degree of snoring ending in the fulminate obstructive sleep apnea condition, is known as a fact.

30 As the disease is closely related to a large variety of physical and mental conditions, treatment is of outmost importance as soon as possible.

DK 177809 B1

Whereas the snoring condition is characterized by the sounds developed by vibrating tissues in the most dorsal area of the pharynx, either the nasopharynx, or the oropharynx or the laryngopharynx, the obstructive sleep apnea is characterized by actual respiration arrest caused by occlusion of the pharyngeal 5 airways.

Apnea appears when the upper airway passages are being sucked close to the rear part of the throat when the person is trying to breathe during sleep. The occlusion can be the result of suction or by the lapse of tonus in the oral soft tissues during the relaxed sleep condition.

10 When the occlusion is there, no air is passing through the pharynx and down to the lungs, and this is the situation called OSAS (Obstructive 9eep Apnea Syndrome).

The obstruction can happen as often as 1000 times during the night time sleep in which the body is depraved from oxygen uptake from the air into the blood 15 stream, which eventually leads to the aggravated symptoms.

The severity of OSAS has been described in the medical literature numerous times giving cause to a number of symptoms and diseases:

General headache High blood pressure 20 Diabetes

Hypoxic pulmonary vasoconstriction Cardiomyopathy

Pulmonary hypertonia with cor pulmonale (increased pressure in the heart-lung circuits) 25 Heart failure, heart arrhythmia, heart attack Day time melancholy or depression I ntelligence alterations

Acid Reflux (GERD - Gastro Esophageal Reflux Disease)

Potency disturbances 30 Worsening of ADHD (Attention Deficit Hyperactivity Disorder), in addition to a large number of problems of a more social character, like, e.g., divorce, decreased labour activity, difficulties in keeping conversations in the track due to tiredness, etc.

35 Thus, compared to a normal control group without diseases, patients suffering from snoring and/or OSAS appear to have: three times as many cases of coronary 2 DK 177809 B1 heart diseases, four times as many cerebral illnesses, such as clots, twelve times as many incidents of car accidents and twice as many labour accidents due to day time sleepiness as a result of lack of sleep and/or impaired sleep quality.

Due to these conditions the life time expectancy is severely limited for these 5 patients, and their quality of life is compromised.

The continuum of snoring diseases gives the following frequency figures: ► 40% of adults over 40 snore (approx. 87 million Americans) ► 9% of men and 4% of women suffer from some form of OSAS (approx. 30 million Americans) 10 ► Less than 10% of OSA sufferers have been diagnosed (Approx 3 million Americans) ► Of those, less than 25% have been successfully treated.

For the above reasons, it is important to provide devices to eliminate æd prevent apnea and the incipient stages thereof.

15 In the prior art, a number of surgical techniques for removal of the tissue involved in the obstruction have been developed, but all of these techniques seem to incur a certain invalidation of the patient and, at the same time, do not have a fully predictable effect.

Furthermore, a number of medical treatments have been tried out with 20 predominantly deficient or sometimes even damaging effect.

Finally, the scientific literature and the patent literature disclose numerous devices for alarming the snoring patient during sleep; devices for tongue thrust, devices for forward movement of the soft palate; devices for obstructing the oral cavity (delimited by the lips), thereby engaging the sound from the snoring; furthermore, 25 mandibular advancement splints or appliances, mouth guard-like devices for provocation of either tongue, hyoid bone or jaw position changes, thereby eliminating snoring; - all of these requiring active participation from competent professionals, such as medical doctors, dentists, etc. Among such prior art devices for or attempts to inhibit snoring, the following are of particular interest in the 30 present context: EP 0 794 749 B1 (I ngemarsson-Matzen & Voss) discloses a jaw position-regulating oral device for preventing snoring and obstructive sleep apnea during sleep. The device consist of two members, a first member to engage with the maxillary dentition and a second member to engage with the mandibular dentition, both 3 DK 177809 B1 connected by a resilient hinge. The mechanism is embedded in the mandibuiar advancement relative to the maxilla. The main difference from the present patent application is the lack of adjustability of the length of the members relative to each other.

5 WO 2013 / 032 884 A1 (Fallon & Jung) discloses a mandibular advancement device with an upper and lower member to engage the maxillary and mandibulary dentition respectively. The lower tray assembly is mated to and slidable adjustable by the patient relative to the upper tray assembly. The main difference from the present patent application is that the device lacks a resilient hinge.

10 WO 2009 / 062 541 A1 (Magning & Magnin) discloses a mandibular advancement orthosis in which the device the comprises a unitary flexible member that can be folded on itself for interaction with the teeth of the upper and lower arches, and an interchangeable flexible strip for surrounding the teeth of the upper arch, having a length that can be modified in order to obtain the desired level of 15 mandibular advancement. The main difference from the present patent application is that the device is regulated by detachable flexible strips and not intrinsic in the device itself.

US 2009 / 0014 013 A1 (Magnin) discloses a mandibuiar advancement splint made of two thermoformable trays designed to envelop the upper and lower arch. The 20 advancement splint includes an articulated frame having rigid and flexible elements immersed in the thermoformable flexible material or molded around it.

The main difference from the present patent application is that the device is made by two separate members without any hinge.

EP 1 719 481 A1 (Ami) discloses a mandibuiar advancement device with a lateral 25 link incorporated into a mandibuiar protrusion device comprising an upper dental tray and a lower dental tray so as to advance or retract the lower dental arch during a vertical movement between the two. The link is adapted to be detachably accommodated in an opening of a ball pivot. The main difference from the present patent application is that the device lacks the intrinsic resilient hinge.

30 EP 2 529 710 A1 (Ash) discloses a device for mandibular advancement in which an upper member and a lower member are interconnected by means of pivotal connection in which at least one is formed as a stud. The main difference from the present patent application is that the device is made of two separate members with detachable attachment cylinders and clamps attached to the outside of the 35 members.

4 DK 177809 B1 GA 223 650 3 A1 (Frantz & Frantz) discloses a mandibular advancement device which uses elastic bands to pull the jaw forward. The upper part having a set of retention hooks and the lower part having a set of interchangeable slide-in posterior occlusal bite planes. The main difference from the present patent 5 application is that the device is using of detachable elastic bands and no intrinsic resilience in any hinge.

WO 2008 / 130 413 A1 (Meade) discloses a mandibular advancement device for pulling the lower jaw forward composed of an upper and a lower member to engage the dentition, where a ball type of hook support is located on both sides of 10 the upper tray at a forward position and a ball type of hook supports are located at a rearward position of both sides of the lower jaw. A tension coil is attached to each of the upper and lower ball type of hook supports. The main difference from the present patent application is that the device uses detachable hooks and spring coils and lack the resilient hinge mechanism.

15 US 2013 / 001 4765 A1 (Meade) discloses a mandibular advancement device for pulling the lower jaw forward composed of an upper and a lower member to engage the dentition, where a ball type of hook support is located on both sides of the upper tray at a forward position and a ball type of hook supports are located at a rearward position of both sides of the lower jaw. A tension coil is attached to 20 each of the upper and lower ball type of hook supports. The main difference from the present patent application is that the device uses detachable hooks and spring coils and lack the resilient hinge mechanism.

WO 2011 / 115 962 A1 (Van Dyke & Tucker) discloses a mandibular advancement splint made of two trays designed to envelop the upper and lower arch. The upper 25 appliance has a pair of adjustable wings attached to the body, and the lower has a pair of fixed wings attached to the body. The upper wings are slidable adjustable.

The main difference from the present patent application is that the device is made of two separate members without any hinge and that it uses detachable pivots in both upper and lower members.

30 US 2010 / 004 380 5 A1 (Kelly) discloses a mandibular advancement device with an upper and lower member to engage with the dentition of the human. The lower dental plate having two pairs of spaced apart pillars and two removable attachable horizontal displacements inserts on the upper part. The main difference from the present patent application is that the device uses detachable vertical 35 displacements inserts and lacks the resilient hinge mechanism.

5 DK 177809 B1 GB 2 284 868 A (Mateijan) discloses an anti-snoring device for oral use, comprising members having upper and lower surfaces which engage the user's maxillary and mandibular dental arches respectively. The upper and lower surfaces are spaced so that the mandible is placed in a forwardly offset position relative to 5 its normal position. The spacing aiso tensions the masticatory muscles to maintain the device in place. The main difference from the present patent application is that the device has no capability of adjustability in antero-posterior directions, and no hinge in the back part of the device.

US 2011 / 001 722 0 A1 (Lindsay et al.) discloses a self- titratable mandibular 10 repositioning device that allows for adjusting the maintained forward position by simply biting-down to preserve the desired degree of mandibular advancement, made of a lower and an upper member to engage the dentition. The main difference from the present patent application is that the device has no resiliency or any hinge.

15 US 2008 / 011 579 1 A1 (Heine) discloses a mandibular advancement device with an intraocclusal removable device in the form of a “U” that is placed covering al! of the upper jaw teeth, wherein two steps, one in each extreme of the lower part of the element, which impede the mandible be closed completely on its norma! occlusion, forcing it to produce a forward displacement of the lower jaw. The 20 main difference from the present patent application is that the device is a one member device with no hinge and only minor protrusive force can be applied to the lower jaw and only in occlusion.

US 2005 / 023 600 3 A1 (Meader) discloses a mandibular advancement device as a single piece of molded plastic with said unit modeled from four theoretical 25 positions including a shield like anterior portion fitted and anchored between anterior teeth-gums and behind the lips. The main difference from the present patent application is that the device is a mono-block decided for prevention of lip closure.

US 2010 / 030 045 8 A1 (Stubbs et al.) discloses a mandibular advancement 30 device with an upper and lower member to engage with the dentition of the human. The members are including a cam associated with one of the jaws and a follower associated with the other jaw. The main difference from the present patent application is that the device is lacking the hinge in the posterior part.

US 2008 / 009 902 9 A1 (Lamberg) discloses a mandibular advancement device 35 composed of a maxillary main body for removable attachment to the maxillary teeth with a protrusive element extending from the central portion of the body 6 DK 177809 B1 and a mandibular removable appliance attached to the mandibular anterior teeth.

The main difference from the present patent application is that the device is having a forcing mechanism on the lower jaw and lacks the posterior hinge, EP 2 491 901 A1 (Garcia Urbano) discloses regulatable intraoral mandibular 5 advancement device for preventing snoring and sleep apnea in which a screw system is located in the central part of the connection between the upper and lower members for the engagement of the dentition. The main difference from the present patent application is that the device is operated by a non intrinsic screw and screwdriver to maintain the regulated forward position of the mandible 10 relative to the maxilla.

AU 1999 476 15 B2 (Palmisano) discloses a mandibular advancement device in which the upper jaw is firmly fitted info an upper plate and the lower jaw is firmly fitted into a lower plate, these two parts are connected by means of opposing flange components located to be lying in an area and close to the posterior teeth.

15 The main difference from the present patent application is that the device is constructed with a pivotal mechanism and not a hinge, US 2013 / 001 476 5 A1 discloses a tongue and mandibular advancement device in which an upper member has hook supports anteriorly and a lower member has a plurality of hook support at the rearward position. The main difference from 20 the present patent application is that the device is constructed by two members separated system without any intrinsic hinge.

EP 0 337 201 discloses an orthodontic appliance comprising a first member to engage with the mandibular dentition and a second member to engage with the maxillary dentition. The two members are resiliency hinged together to keep the 25 upper and lower jaw in a normal position. The main difference from the present patent application is that the device is lacking the adjustability in the sagital plane, thereby delimitating the usability as a snoring preventing device.

WO 92/11827 discloses an anti-snoring device for oral use consisting of a horseshoe-like upper jaw member for engaging the maxillary dentition, with the 30 downward extending flange intended to extend into the lingual vestibule in order to maintain a forward posture of the lower jaw. The main difference from the present patent application is that the device is using a forcing mechanism on the lower jaw.

EP O 312 368 discloses an anti-snoring device for oral use which resembles the 35 above-mentioned device, the main difference being the design of the airway 7 DK 177809 B1 passage. The main difference from the present patent application is that the device is using a forcing mechanism on the lower jaw.

WO 92/05752 (Wu) discloses an anti-snoring device for oral use consisting of a spatial member congruent with the palate and a lower member adapted to the 5 lingual aspects of the surfaces of the dentition in the lower jaw, hooks being attached to the occlusive plane of the device for fixing the two jaws in a predetermined relation. The main difference from the present patent application is that the device is using detachable elastics and has no resilient hinge.

US 5,313,960 (Tomasi) discloses an anti-snoring device for oral use consisting of 10 two horseshoe-like individually shaped mouthpiece portions which are connected and fixed in a predetermined position in which the lower jaw protrudes in relation to the upper jaw. The main difference from the present patent application is that the device is using a predetermined forward position of the lower jaw relative to the upper jaw, and there is no resilient hinge.

15 US 7,910,502 B1 (Nguyen & Nguyen) discloses an anti-snoring device for oral use consisting of two horseshoe-like individually shaped mouthpiece portions which are connected and fixed by an assembly of tubes, hooks and screws to be attached to the two separate members. The main difference from the present patent application is that the device is using detachable screws, spring coils and 20 loops to keep the mandible in a forward position, meaning that there is no intrinsic resilient hinge. Therefore the device is much more complicated and technical demanding, with an additional disadvantage of plaque accumulation and deteriorated hygiene to follow.

DE 201 02 432 U1 (Trentepohl et al.) discloses an anti-snoring device for the oral 25 use comprising an upper and lower member to engage with the maxillary and mandibulary dentition interconnected by an adjustable telescopic device which is attached at the outer surface of the members. The main difference from the present patent application is that the device is using detachable telescopic devices to keep the mandible in a forward position. Thus the device lacks the intrinsic 30 resilient hinge. Also the device is much more complicated and technical demanding, with an additional disadvantage of plaque accumulation and deteriorated hygiene to follow.

WO 21013 049 751 A2 (Rogers) discloses a method for use in connection with sleep-disordered breathing, of forming oral orthotic systems to position and /or 35 stabilize a mandible of a patient includes providing an upper dental member adapted to be placed in connection with upper dentition of the patient, providing a 8 DK 177809 B1 lower dental member adapted to be placed in connection with lower dentition of the patient providing a plurality of posterior mounting structures. Each of the posterior mounting structures is adapted to be attached to one of the upper dental member or the lower dental member at a posterior, buccal position thereon. Each 5 of the posterior mounting structures includes a plurality of positions at which one of the pluralities of connectors is attachable to the extending member. Force may be applied to the mandible of the patient via at least one of a plurality of different mechanisms via attachment of a component of the mechanism to at least one of the posterior mounting structures. The upper dental member and the lower dental 10 member are formed, independently, from at least one polymeric material. The main difference from the present patent application is that the device is using multiple detachable mounting structures to keep the mandible in a forward position. Thus the device lacks the intrinsic resilient hinge. The upper and lower members are constructed after direct impressions of the user’s teeth, and then 15 separately in a second laboratory procedure casts the hard polymeric (acrylic) material to form congruent trays for the upper and lower jaws. As this system is using hard acrylic material it substantially differ from the present patent application in function, durability and comfort. This gives a disadvantage in regard to monetary price for the end user. Also the device is much more complicated and 20 technical demanding, with an additional disadvantage of plaque accumulation and deteriorated hygiene to follow.

US 2013 009 837 2A1 (Webster et al.) discloses an oral appliance for prevention of sleeping problems, including snoring, sleep apnea and bruxism. Specifically the device alters the position of the mandible and is made of a one piece device 25 molded from a flexible polymer. Both upper and lower dental trays include inner and outer wails which increase contact area with the teeth. The hinge mechanism of the device includes a positive positioning system comprised of upper and Sower opposed interlocking ridges. The ridges serve to create offset between the position of the upper and lower tray relative to each other, therefore advancing the user’s 30 mandible. The main difference from the present patent application is that the device is a one-piece device folded on a fixed point in the back most posterior part of the device to keep the mandible in a forward position. The interlocking ridges keep the lower and upper trays in a fixed forwarded position, thereby merely prohibits the other vice rolling possibility of the device leading into misuse of the 35 intention of the device. Also there is no kind of incremental adjustability. Hence there is no individualization possibility.

US 2011 022 626 1A1 (Hernandez) discloses a mouthpiece for reducing snoring.

The mouthpiece includes an upper guard configured to fit over the upper teeth of 9 DK 177809 B1 the user, a lower guard configured to fit over the lower teeth of a user, a spacer assembly provided between the upper guard or the lower guard to provide an air passage at the middle section of the mouthpiece, a first adjustable assembly attached to the left side of the upper guard and the left side of the lower guard, 5 and a second adjustable assembly attached to the right side of the upper guard and the right side of the lower guard. The first adjustable assembly and the second adjustable assembly are operable to move the lower guard relative to the upper guard. The main difference from the present patent application is that the device is using detachable blocks and screws devices to keep the mandible in a 10 forward position. Although the device depicts a kind of hinge (flexible coplanar connectors), this hinge is mereiy decided for avoiding sharp edges at the posterior part of the two members and for ease and economy of manufacture , and can not function as an actuai durable active hinge due to the fact that the screws in the blocks are rigid. In conclusion, the device is much more complicated and technical 15 demanding, with an additional disadvantage of plaque accumulation and deteriorated hygiene to follow.

WO 01 302 60 A1 (Bergersen) discloses a patent application as an intra-oral appliance for repositioning the user’s mandible anterior to the user’s maxillary teeth, thus opening the user’s oral, pharyngeal passageway preventing snoring 20 and sleep apnea. The appliance is two U- shaped plates joined to form a hinge.

The lower plate has lingual tabs which are employed to help position the appliance. The main difference from the present patent application is that the device is completely lacking any kind of incrementally adjustability. Also the WO 01 302 60 A1 is merely a transcription of the original patent EP 0 794 749 B1 25 (I ngemarsson-Matzen & Voss) except the lingual tabs which in the original version is a solid moldable block.

Disclosure of the Invention

While the above devices represent attempts to solve the snoring and apnea 30 problems, they are ail rather complicated in their design and most of these require the interaction of a professional team in their individual design. Furthermore, they are rather discomfortable for the wearer, and they do not appear convincing with respect to their capability of achieving an effective and long-lasting anti-snoring effect.

35 Thus, there is a demand for a relatively comfortable device which provides a high degree of inhibitory effect on snoring during even long sleeping periods, such as 10 DK 177809 B1 overnight, without adverse effects on the structures involved, and which at the same time is easy and simple to use and wear for normal non-skilled persons.

The present invention provides such a device.

The adjustable anti-snore device according to the invention comprises an upper 5 member adapted to engage the maxillary dentition of a human and a lower member adapted to engage the mandibulary dentition of the human, the upper and lower members being resiliently or mechanically hinged together, wherein the resiliency of the hinging is adapted to allow the physiological movement of the lower jaw in the sagital plane while retaining a forward position of the lower jaw 10 relative to the upper jaw and thereby keeping the airway passage in the nasopharynx, the oropharynx and the hypopharynx substantially free of occlusion, while at the same time embody the adjustability in one or two form, i.e. incremental and / or successive.

The device according to the invention combines three essential functions: the 15 forward positioning of the lower jaw relative to the upper jaw, the hinging, and the adjustability of the sagital relation between the two members. As will be explained below, the forward positioning of the lower jaw is essential to prevent occlusion of the airway passage in the pharyngeal space during sleep. The resilient or mechanically hinging makes it possible and realistic to maintain the forward 20 positioning of the lower jaw even during movements in the sagital plane which unavoidably occur during sleep. And the adjustability makes it useful for even the smallest and the largest person wearing the device. This essential combination of features which ensures constant non-constricted airflow and unrestricted movement in the sagital plane and thereby ensures a constant efficient function 25 without risk of the device falling out of the mouth of the user and without any substantial discomfort together with the adjustability which even allows some horizontal movements, distinguishes the device according to the invention from all of the abovementioned prior art devices.

The device according to the invention may be made of any material, such as 30 metal, alloy, wood, plastics, etc. provided that the device made feels soft and comfortable in the mouth without any constriction or damaging of the tissue, such as gums, tongue, teeth, but at the same time is sufficientiy capable of retaining its shape and of exerting a sufficient resiliency towards the muscular tension and forces acted upon the jaws so that it will maintain the lower jaw in the anterior 35 position while allowing normal movements during sleep. The material used for the device according to the invention should not contain any allergens or other kind of toxic ingredients.

11 DK 177809 B1

The device according to the invention is preferably made of a resilient non-toxic plastics material, such as a polyvinyl resin, including a vinyl acetate-ethylene copolymer such as poly (ethyi vinyl acetate), or a polyolefin such as polyethylene or polypropylene.

5 it is particularly preferred that the resilient non-toxic plastics material is a thermoplastic material, such as a cellulose derivative, a vinyl polymer, a polystyrene, a polyamide, an acrylic resin, etc., which can be shaped to adapt to an individual dentition by moderate heating, such as heating to a temperature above normal human body temperature, that is, a temperature of at least 40°C 10 and at the most 80°C, e.g. about 70°C. The material presently most preferred by the inventor is ethylene vinyl acetate copolymer.

The device according to the present invention may be manufactured by plastics molding, such as cold molding, compression molding, injection molding, etc. The manufacturing method presently most preferred by the inventor is injection 15 molding.

The upper and lower members are preferably integrated with each other through resilient hinges made of the same material as the upper and lower members.

However, the hinges may be reinforced and their resiliency enhanced by insertion, such as cast in, etc., into the hinges of a resilient member, such as a resilient 20 plastics member, a metallic resilient member, such as a flat spring, a laminated spring etc. etc., or simply by a mechanical connection.

The adjustability according to this invention, being embedded or glued, gilded or otherwise attached to the membering parts for the engagement of the dentition, in the upper maxillary member, the lower mandibulary member or both members 25 at the same time, being incremental is a major novelty and Is unique for this device.

As it will be understood the adjustability is embedded in the anterior parts of the upper and / or lower members of the device thus keeping the posterior resilient or mechanic hinge intact.

30 The adjustability of the protrusion of the mandible relative to the maxilla is made adjustable by the means of embedding a positive structure in either the forward moving part or the device and a negative structure in the stable part of the device or vice versa. The positive part may be constructed as a knob, rod, hook or alike, whereas the corresponding negative structures would be holes, cylinders and 35 loops in this aspect. Other configurations may apply. Thus regardless on the 12 DK 177809 B1 structure selected, knob, rod or hook etc. the adjustability will express itself as an incremental (stepwise) adjustable mandibular advancement device.

One aspect of the invention is a device in which the incrementally adjustable mechanism is embedded in the mandibular part of the device so the mandible can 5 be protruded when the knobs and holes are detached from its original position and reattached in a more advanced longitudinal form of the mandible part of the device.

Another aspect of the device is a device in which the incrementally adjustable mechanism is embedded in the maxillary incisal, canine or premoiar region of the 10 device so the maxilla can be retracted when the knobs and holes (or any of the other described adjustability forms) are detached from its original position and reattached in a more tightened position. In this way the circumference of the dental arch of the device will decrease. As the maxilla is not able to move, the result of this maneuver will be the forward displacement of the mandible from its 15 original position.

A particularly preferred way of shipping the device according to the invention to the end consumer is as a kit comprising the device and a temperature indicator adapted to indicate a temperature change to an elevated temperature at which the material of the device can be shaped. This makes it simple and safe for the 20 end user to mold the device to conform to his or hers specific dentition simply by heating the relevant domain of the device in water at the temperature of which is kept in the correct temperature range for the material in question by using the indication of the temperature indicator.

It should be understood that the use of the anti-snore device according to the 25 invention is not limited to prevention or reduction of snoring or OSAS but the device is applicable in any situation where it is desirable to secure free airway passage in human beings, such as during recovery from anesthesia, during unconsciousness, etc.

The unique combination of posterior resilient / mechanic hinging, dentition 30 engagement and adjustability discussed above can also, according to another aspect of the invention, be utilized in a device for relieving guided transpositions of the jaws.

In this latter aspect, the invention relates to an orthognatic function device comprising an upper member adapted to engage with the maxiliary dentition of a 35 human and a lower member adapted to engage with the mandibulary dentition of the human, the upper and lower members having bases which prevent direct 13 DK 177809 B1 contact between opposing teeth, thereby eliminating guided transposition of the jaw relation and the upper and lower members being resiliency hinged together in such a manner together with the adjustability that the lower jaw of the human is kept positioned in a normal position relative to the upper jaw, allowing vertical 5 movement and, in the occluded intercuspidal position, allowing horizontal movement so that the temporo mandibular joint is kept substantial in its resting position, both when the lower jaw is at rest and when it is working.

It will be understood that also in this aspect, the resiliency of the hinging should be adapted to allow the physiological movement of the lower jaw in the sagital 10 plane, and that the above comments concerning selection of suitable materials, manufacturing method, and adaptation to the individual dentition by shaping the material in a softened, e.g. heat-softened, condition apply also to this aspect of the invention.

Thus, the orthognatic aspect of the invention provides a completely new 15 philosophy in relieving temporo mandibular joint disorders caused by irregular dentition: In contrast to known orthognatic devices, the orthognatic device according to the invention is hinged in such a way that no interference between the upper and lower members can occur, thereby alleviating symptoms caused by abnormal interference from irregular dentition. Furthermore, tensions caused by 20 tooth grinding and clenching are alleviated. At the same time, this orthognatic device is much simpler to adapt to the individual needs of the person in question than conventional orthognatic devices, and it can even be used by the individual consumer without assistance by any professional.

In the following, the incremental mandibular advancement anti-snoring device 25 aspect of the invention will be explained in further detail with reference to the accompanying drawings.

Description of the use of the device according to the invention

The preferred method of using the device described above and in the figures is to 30 insert the device in the mouth of the affected individual, at nighttime before sleep.

By inserting the device in the mouth in the way that the mandible is forced a bit forward relative to the maxilla, increased airway space will appear in the back of throat, the pharynx, and thereby facilitate the free flow of air with its oxygen for the bodily metabolism at large.

14 DK 177809 B1

Sometimes the alignment of the teeth is not congruent with the idea! shape of a perfect dentition, and therefore the need for special modifications can prevail. To accomplish this task, the preferred material used for the device according to this invention, is made of a thermoplastic material, which can be subjectively moulded 5 to adapt more perfect to the users non-perfect alignment of the teeth. Simply by immersing that actual part of the device, that needs modulation, into water at a prefixed temperature according to the material specification, the material can be moulded and hence get in closer contact with alignment of the wearers dentition.

When it returns to the temperature of the room, or inside the mouth, the device 10 will keep its new dimension, and thereby alleviate any hard or any loose contact with the teeth, thereby making it much more comfortable to wear during the sleep.

This procedure can be done by almost everybody with a little exercise, and does not need to acquire the competence and time from a professional dentist, doctor 15 or technician at all.

One aspect of the incremental mechanism of the device according to the invention is that the wearer of the device can be given numerous possibility to calibrate his own degree of forwarding the mandible relative to the maxilla, by the use of any or all of the incrementally mechanisms described above.

20 For instance if the wearer of the device wants to elongate the mandible, simply detach the device parts, find a new location for the parts relative to each other and then attach again. In one particular case the mandible part can be detached from the maxillary part integrated with the hinge, forwarded or retracted from the previous position, then reattach the snap-on mechanism, and the effect of the 25 device will change, with the result of more or less free airway space in the pharynx (depending on weather the user elongated or diminished the relative length).

In another particular case the maxillary part can be detached from the mandibulary part integrated with the hinge, forwarded or retracted from the 30 previous position, then reattach the snap-on mechanism, and then again the effect of the device will change.

Yet in another particular case the maxillary part can be adjusted one or more steps in one side of the device (right or left), and the mandibular part of the opposing side (left or right) can be adjusted one or more steps individually from 35 the other side. This part of the device modification can give the benefit of alignment to dentitions that are asymmetric or any other kind of special needs.

15 DK 177809 B1

In some cases the user of the invention would prefer the incremental mechanism just to be situated in the front midline of the maxillary part of the device, and then for this is expressed through the description and the drawings. If the midline incremental mechanism is opened (detached snap-off) the circumference of the 5 maxilla can be enlarged or diminished. If the arch circumference is enlarged relative to the mandible, the mandible is falling back towards its normal (airway occluding) position, whereas if the arch circumference is diminished the mandible is being forced further forward and thereby reliefs the occluded airway passage.

Any of the above alterations of the position between the two jaws, can be made 10 with or without the use of the temperature sensitive alteration of the thermoplastic materials.

Another aspect of the device according to the invention is that the wearer of the device can fix the relative position of the maxillary part relative to the mandibulary art by the use of heating, either from the warmed water or from the metal rod 15 that can be provided in one way of delivering the device package. When the wearer have accomplished the desired position he can immerse the device into the heated water and fix the position there by locking the negative and positive structures to each other, or he can use the metal rod to melt a part of the connected devise to prevent it from leaving the accomplished and desired 20 position.

Description of figures in the figures and drawings in which,

Fig. 1 Shows the Incremental version of the Adjustable Mandibular 25 Advancement Device top view in an oblique perspective in its Neutral position

Fig. 2 Shows the Incremental version of the Adjustable Mandibular

Advancement Device bottom view in an oblique perspective in its Neutral position 30 Fig. 3 Shows the Incremental version of the Adjustable Mandibular

Advancement Device bottom view in a perpendicular perspective in its Neutral position 16 DK 177809 B1

Rg. 4 Slows the incremental version of the Adjustable Mandibular

Advancement Device top view in a perpendicular perspective in its Neutral position

Rg. 5 Shows the Incremental version of the Adjustable Mandibular 5 Advancement Device from aside in its Neutral position

Rg. 6 Shows the Incremental version of the Adjustable Mandibular

Advancement Device in cross section at line A in fig. 3 in its Neutral position

Rg. 7 Slows the Incremental version of the Adjustable Mandibular 10 Advancement Device in cross section at line B in fig. 3 in its Neutral position

Rg. 8 Shows enlarged schematic details of the incremental mechanism with taps and corresponding holes

Rg. 9 Shows the Incremental version of the Adjustable Mandibular 15 Advancement Device top view in an oblique perspective in its maximal elongated position

Rg. 10 Shows the Incremental version of the Adjustable Mandibular

Advancement Device bottom view in an oblique perspective in its maximal elongated position 20 Rg. 11 Shows the Incremental version of the Adjustable Mandibular

Advancement Device bottom view in a perpendicular perspective in its maximal elongated position

Rg. 12 Shows the Incremental version of the Adjustable Mandibular

Advancement Device top view in a perpendicular perspective in its 25 maximal elongated position 17 DK 177809 B1

Rg. 13 Shows the incremental version of the Adjustable Mandibular

Advancement Device from aside in its maximal elongated position

Rg. 14 Shows the incremental version of the Adjustable Mandibular

Advancement Device in cross section at line A in fig. 11 in its maximal 5 elongated position

Rg. 15 Snows the incremental version of the Adjustable Mandibular

Advancement Device in cross section at line B in fig. 11 in its maxima! elongated position

Rg. 16 Snows the incremental version of the Adjustable Mandibular 10 Advancement Device in its four components top view oblique perspective

Rg. 16 a Snows the mandibulary lower member to engage with the maxillary dentition of the i ncremental version of the Adjustable Mandibular

Advancement Device top oblique view 15 Rg. 16 b Snows the maxillary upper member to engage with the mandibular dentition of the I ncremental version of the Adjustable Mandibular

Advancement Device top oblique view

Rg. 16 c Shows the Hinge mechanism connecting the upper maxillary and lower mandibulary members of the Incremental version of the Adjustable 20 Mandibular Advancement Device in a top oblique view.

Rg. 17 Shows the Incremental version of the Adjustable Mandibular

Advancement Device in its four components bottom view oblique perspective

Rg. 17 a Shows the mandibular lower member to engage with the mandibular 25 dentition of the I ncremental version of the Adjustable Mandibular

Advancement Device bottom view oblique perspective 18 DK 177809 B1

Rg. 17 b Shows the maxiliary upper member to engage with the maxillary dentition of the Incremental version of the Adjustable Mandibular Advancement Device bottom view oblique perspective

Rg. 17 c Shows the Hinge mechanism connecting the upper maxillary and lower 5 mandibulary members of the Adjustable Mandibular Advancement

Device in a bottom oblique view

Rg- 18 Shows the single member adjustable Incremental version of the Adjustable Mandibular Advancement Device top view in an oblique perspective in its Neutral position 10 Rg. 19 Shows the single member adjustable Incremental version of the

Adjustable Mandibular Advancement Device bottom view in an oblique perspective in its Neutral position

Rg. 20 Shows the single member adjustable Incremental version of the Adjustable Mandibular Advancement Device bottom view in a 15 perpendicular perspective in its Neutrai position

Rg. 21 Shows enlarged schematic details of the incremental mechanism with taps and corresponding holes in just one of the members at line A-A in fig. 20 in its maximal elongated position

Rg. 22 Slows the single member adjustable Incremental version of the 20 Adjustable Mandibular Advancement Device top view in an oblique perspective in its maximal elongated position

Rg. 23 Shows the single member adjustable I ncrementa! version of the

Adjustable Mandibular Advancement Device bottom view in an oblique perspective in its maximal elongated position 19 DK 177809 B1

Rg. 24 Shows the single member adjustable Incremental version of the Adjustable Mandibular Advancement Device bottom view in a perpendicular perspective in its maximal elongated position

Hg. 25 Shows the single member adjustable Incremental version of the 5 Adjustable Mandibular Advancement Device bottom view in an oblique perspective with detached members

Rg. 26 Shows the single member adjustable Incremental version of the Adjustable Mandibular Advancement Device top view in an oblique perspective with detached members 10 Rg. 27 Shows in detail the knob part of the incremental mechanism

Rg. 28 Shows in detail the hole part of the incremental mechanism

Rg. 29 Shows a cross section of the griping mechanism in its maximum enlarged stage

Rg. 30 Shows a diagrammatic representation of the limitations of the 15 movements of the lower jaw in any direction in the sagita! plane where PCP stands for the most protruded contact point of the teeth, IC stands for intercuspida! position (the maximal closing point), RCP stands for the most retracted contact position for the teeth, and MOP stands for the maximal opening point.

20 Rg. 31 Slows the single member Saw-tag I ncremental version of the

Adjustable Mandibular Advancement Device top view in an oblique perspective in its Neutral position. Note that the essential aspect of the Saw-tag incremental version of the Incrementally Adjustable Mandibular Advancement Device is the fact that the negative structures is lying IN 25 the material and does not penetrate the material as in the previously described version of the Incrementally Adjustable Mandibular Advancement Device.

20 DK 177809 B1

Rg. 32 Shows the single member Saw-tag Incremental version of the

Adjustable Mandibular Advancement Device bottom view in an oblique perspective in its Neutral position.

Rg. 33 Shows the single member Saw-tag incremental version of the 5 Adjustable Mandibular Advancement Device in cross section at line B in fig. 3 in its Neutral position.

Rg. 34 Shows the single member Incremental version of the Adjustable

Mandibular Advancement Device in cross section at line B in fig. 3 in its maximal elongated position.

10 Rg. 35 Shows the single member adjustable saw-tag Incremental version of the Adjustable Mandibular Advancement Device bottom view in an oblique perspective in its detached position.

Rg. 36 Shows enlarged schematic details of the saw-tag incremental mechanism with positive embedded tabs in the maxillary part and 15 corresponding embedded cavities in mandibuiar part of the invention.

Rg. 37 Slows the activated view of the three piece version of the Incremental version of the Adjustable Mandibuiar Advancement Device shown in figs. 1 through 6, and 9-17 in an obiique frontal upper view.

Rg. 38 Slows the activated view of the three piece version of the Incrementai 20 version of the Adjustable Mandibuiar Advancement Device shown in figs. 1 through 6, and 9-17 in an obiique dorsal lower view.

Rg. 39 Shows the activated elongated view of the three piece version of the Incremental version of the Adjustable Mandibular Advancement Device shown in figs. 1 through 6, and 9-17 in an obiique frontal view.

21 DK 177809 B1

Rg. 40 Slows the activated elongated view of the three piece version of the Incremental version of the Adjustable Mandibular Advancement Device shown in figs. 1 through 6, and 9-17 in an oblique almost cranial view.

Rg. 41 Slows the activated elongated view of the three piece version of the 5 Incremental version of the Adjustable Mandibular Advancement Device shown in figs. 1 through 6, and 9-17 in an oblique bottom view.

Rg. 42 Snows the activated elongated view of the three piece version of the Incremental version of the Adjustable Mandibular Advancement Device shown in figs. 1 through 6, and 9-17 in an oblique lateral view 10 detached.

Rg 43 Slows the activated elongated view of the three piece version of the I ncremental version of the Adjustable Mandibular Advancement Device shown in figs. 1 through 6, and 9-17 in an oblique almost frontal view detached.

15 Rg. 44 Slows the activated elongated view of the saw-tag version of the

Incremental version of the Adjustable Mandibular Advancement Device shown in figs. 31 through 35, in an oblique almost frontal view detached.

Rg. 45 Shows the activated elongated view of the saw-tag version of the 20 Incremental version of the Adjustable Mandibular Advancement Device shown in figs. 31 through 35, in a bottom dorsal oblique perspective detached.

Rg. 46 Slows the Midline Maxillary Incremental version of the Adjustable Mandibular Advancement Device top view in a perpendicular 25 perspective in its Neutral position.

22 DK 177809 B1

Rg. 47 Slows the Midline Maxillary Incremental version of the Adjustable Mandibular Advancement Device front view in its Neutral position (mandibular part not shown here).

Rg. 48 Slows the Midline Maxillary Incremental version of the Adjustable 5 Mandibular Advancement Device bottom view in a perpendicular perspective in its Neutral position.

Rg. 49 Slows the Midline Maxillary incremental version of the Adjustable Mandibular Advancement Device sagitai trans-sectional view in the midline shown as line A-A in fig. 48, in its Neutral position.

10 Rg. 50 Slows the incremental mechanism with its positive and negative structures interconnected. It can be seen that the two slices of the facial wall of the maxillary part, when joined, exhibits as the original facial wall as seen in figs. 1 - 7, 9 -26, 31 - 35, and 37 - 45.

Rg. 51 Shows the Midline Maxillary Incremental version of the Adjustable 15 Mandibular Advancement Device side view in a perpendicular perspective in its Neutral position.

Rg. 52 Shows the Midline Maxillary I ncremental version of the Adjustable

Mandibular Advancement Device in a dorsal view in its Neutral position.

The incremental mechanism is shown in its natural non-eiongated 20 position.

Detailed description of the nomenclature used in the description of the

FIGURES

In Figs. 1 through 45, in which like numerals indicate like parts, the device 1 25 according to the invention consists of two horseshoe-like members 2 aid 3 of a soft, resilient plastics material, preferably a thermoplastic material, such as an 23 DK 177809 B1 ethylene vinyl acetate copolymer, or any suitable material, hinged together by means of integrated resilient or mechanical hinges 4 and 4'. Surfaces 5 and 6 represent the lower surface of the upper member (2) and the upper surface of the lower member (3), respectively. 7 indicates the lingual flange of the lower 5 member (3) adapted to the lingual surfaces of the lower incisors, canines and premolars, this flange 7 being the part of the device which actually forces the lower jaw forward. 8 is the facial surface of the lower member (3), 9 is the facial surface of the upper member (2), and 10 is the lingual surface of the upper member (2). The conjoining effect of forces exerted by the facial surface 9 of the 10 upper member (2) and the lingual surface 7 of the lower member (3) keep the lower jaw in a forward position relative to the upper jaw. As the facial surface 8 and the lingual surface 10 do not exert any forces, their dimensions are rather uncritical and some embodiments of the invention may even be provided without these surfaces. No. 11 indicates the tunnel shaped space of the upper member (2) 15 to engage with the upper dentition and 12 indicates the tunnel-shaped space of the lower member (3) adapted to engage the lower dentition. When the device is compressed to an active position convexity 13 appears at the posterior end part of the device and a concavity 14 at the anterior part of the hinging. The occusal knots, 15 are designed to prevent complete occlusion and lack of airspace 20 between the members 2 and 3. No. 16 indicates the incremental mechanism, 17 is the Lateral facial portion of the lower mandibular member (3) at the molar and premolar area, 18 is the Medial palatine portion of the upper maxillary member (2) at the molar and premolar area, 19 shows the Lingual wall of mandibular member (3) closest to the tongue. 20 is the Positive structure of the incremental 25 mechanism, 21 the Negative structure of the incremental mechanism, 22 the

Hinge member part of the invention with its negative structures of the incremental mechanism. 24 is the Lateral facial portion of the maxillary member (2) at the molar and premolar area, 25 the Lingual wall of mandibular member (3) closest to the teeth. No. 39 is the intercupidai position (IP) in which the dentition of the 30 mandible makes the maximal interference with the dentition of the maxilla; 40 is 24 DK 177809 B1 the protruded contact position (PCP) in which the mandible has made the maxima! protruded movement from the IP position, still keeping some contact with the dentition of the maxilla; 41 is the retracted contact position (RCP) in which the mandible have made the maxima! retraction from the IP position, still keeping 5 some contact with the dentition of the maxilla, and 42 is the maximal opening point (MOP) in which the mandible has made the maximal opening movement from the IP position, ail of which only being restricted by the muscles, the teeth, the ligaments and the discus involved in the temporo-mandibuiar joint system, 42 indicates the border describing the curve in which the mandible can slide open 10 from the RCP, 43 is the border describing the curve in which the mandible can slide open from the PCP. No. 44 shows the Bottom view of the mandibular part of the saw-tag attachment structure and 45 is the Top view of the mandibular part of the saw-tag incremental mechanism, 46 is the Mandibular member part of the invention with its negative structure for engaging with the positive maxillary part 15 structures of the saw-tag incremental mechanism and 47 is the Maxillary member part of the invention with its positive structure for engaging with the negative mandibulary parts structures of the saw-tag incremental mechanism. 48 is indicating the section line between the sliced part of the maxillary facial band in the closest proximity to the maxillary dentition especially in the region from the 20 premolars in the right side to the premolars in the left side.

25 25

Claims

1. A stepwise (gradually) adjustable lower jaw advancing anti-snoring and obstructive sleep apnea preventive device (1) consisting of an upper portion for enclosing contact to the human maxillary (upper jaw) tooth set and a lower portion for enclosing contact with it. human mandibular (lower jaw) tooth sets characterized in that the upper portion (upper jaw portion) and lower portion (lower jaw portion) are resilient or mechanically hinged, and wherein these parts (maxillary and mandibular) are incrementally adjustable relative to each other, Adapted to follow the physiological movements of the lower jaw in the sagittal plane, while maintaining a forward displacement of the lower jaw relative to the upper jaw, thereby establishing as far as possible free air passage in the nasopharynx, oropharynx and hypopharynx.

2. A stepwise (gradually) adjustable lower jaw advancing anti-snore and 15 obstructive sleep apnea preventive device (2) consisting of an upper portion for enclosing contact with the human maxillary (upper jaw) tooth set and a lower portion for enclosing contact with it. human mandibular (lower jaw) tooth sets characterized in that the upper portion (upper jaw portion) and lower portion (lower jaw portion) are resilient or mechanically hinged, and one of said parts (the mandibular) being incrementally adjustable relative to the other (the maxillary), whereby the hinge is adapted to follow the physiological movements of the lower jaw in the sagittal plane, while maintaining a forward displacement of the lower jaw relative to the upper jaw, thereby establishing as far as possible free air passage in the nasopharynx, oropharynx and hypopharynx. .

3. A stepwise (gradually) adjustable lower jaw advancing anti-snoring and obstructive sleep apnea preventive device (3) consisting of an upper portion for enclosing contact with the human maxillary (upper jaw) tooth set and a lower portion for enclosing contact with the human mandibular 30 (lower jaw) tooth set characterized in that the upper portion 30 (upper jaw portion) and the lower portion (lower jaw portion) are resilient or mechanically hinged, and wherein one of these parts (the maxillary) is incrementally adjustable in relation to to the other (the mandibular), whereby the hinge joint is adapted to follow the physiological movements of the lower jaw in the sagittal plane, while maintaining a forward displacement of the lower jaw relative to the upper jaw, thereby establishing as far as possible free air passage in the nasopharynx, oropharynx and hypopharynx.

A device according to claim 1 wherein the stepwise regulating mechanism is included (embedded) in both the upper (maxillary) and the lower (mandibular) portion of the device.

A device according to claim 2, wherein the stepwise regulating mechanism is embedded in the lower (mandibular) portion of the device.

A device according to claim 3 wherein the stepwise regulating mechanism is embedded in the upper (maxillary) portion of the device.

A device according to any one of claims 1-3, wherein the stepwise regulating mechanism comprises a multiple stepwise pushbutton embedded in either the mandibular portion or the maxillary portion of the device or in both portions at the same time.

A device according to any one of claims 1-3, wherein the stepwise regulating mechanism is comprised of multiple stepwise pushbuttons which can be attached to either the maxillary portion or the mandibular portion separately or both.

A device according to any one of claims 7 and 8, wherein said stepwise regulating mechanism comprises multiple stepwise pushbuttons, said pushbuttons being respectively positive (male) and negative (female) structures of various shapes such as round, square, hexagonal, and the like, which are designed to integrate with the corresponding opposing party having negative structures. 31 DK 177809 B1

A device according to claim 9 in which the multiple step-by-click clicks of structures are top lobed with a varying number of segments.

A device according to any one of claims 9-10 wherein the multiple incremental negative (female) clicks - structures are lobulated with a varying number of segments.

A device according to any one of claims 1-3, wherein the stepwise mechanism can be disconnected from the base portion of the device (consisting of the upper maxillary portion, the lower mandibular portion and the hinge joint), renewed, repaired and repositioned on the relevant portion. again.

A device according to any one of claims 9-11 wherein the negative (female) structures of the device parts are completely encumbered by either the maxillary or the mandibular portion of the device for direct interaction with the opposite part of the device.

A device according to any one of claims 1-3, wherein the upper part of the device has an anterior (facial) wall that can be adapted to be in contact with the anterior (facial) surface of front teeth, canines and premolars (small cheek teeth). ) in the upper jaw and at the same time exhibiting absence of lingual (palatinal) wall for contact with the palatal surfaces of the same 20 teeth, and the lower part of the device having a posterior wall which can be adapted to be in contact with the posterior (lingual) surfaces. of front teeth, canines and premolars (small cheek teeth) in the lower jaw, and at the same time exhibit the absence of contact with the facial (anterior) surfaces of the lower jaw teeth.

A device according to any one of the preceding claims, wherein the upper (maxillary) portion and the lower (mandibular) portion are made of a non-toxic thermoplastic material that can be molded to the individual dental position by moderate heating.

A device according to any one of claims 1-3, wherein the upper and lower 30 parts of the device are integrated with each other by means of a resilient 32 (flexible - flexible) hinge joint made of the same material as the upper and lower parts. the lower part of the device.

A device according to any one of claims 1-3 wherein the hinge joint is located in and integrated into the most dorsal (posterior) portion of the device and 5 wherein the joint is resilient due to the material it is made in itself.

A device according to claims 16 and 17 wherein the most dorsal portion of the hinge joint is convex in the posterior portion and concave in the most anterior portion of the hinge joint when the device is located in the patient's mouth.

A device according to any one of claims 1-3 wherein the stepwise mechanism is integrated into the maxillary middle most frontal portion of the device closest to the teeth from the left side premolars to the right side premolars.

A kit (overall set) consisting of a device according to any one of the preceding claims, together with a temperature indicator adapted to indicate the pupil temperature change at which temperature the material used in the manufacture of the device can be individually adjusted.

A kit (assembled kit) according to claim 20 with a metal bar enclosed in insulating material for use in fusing the sliding stepwise change of the device, at the desired advanced step in the relationship between the maxillary portion and the mandibular portion of the device. .

A method of producing the incremental mandible feeding device according to any one of claims 1 to 21. 33